Attorney General Bonta Secures Major Court Victory Protecting Gender-Affirming Care Under the Affordable Care Act

OAKLAND - Co-leading a multistate coalition alongside the attorneys general of Massachusetts and New Jersey, California Attorney General Rob Bonta yesterday secured a major victory after the U.S. District Court for the District of Massachusetts struck down a key provision of a Trump Administration final rule that would have excluded coverage of certain types of gender-affirming care as essential health benefits under the Affordable Care Act (ACA). Essential health benefits are subject to the ACA's financial protections, including limits on out-of-pocket costs.

"Everyone deserves access to health coverage," said Attorney General Bonta. "The Trump Administration tried to exclude gender-affirming care from qualifying as an essential health benefit. We fought back, and the court's ruling means this care can - and in many states must - qualify for the ACA's financial protections, ensuring transgender people have an equal opportunity to benefit from the ACA."

The final rule at issue - the "Marketplace Integrity and Affordability" rule - was proposed by the Trump Administration in March 2025 to curb alleged ACA enrollment fraud and reduce federal spending on subsidies that help consumers afford ACA coverage. Among other changes, the rule would have removed certain types of gender-affirming care from the ACA's 10 essential health benefit categories.

In July 2025, Attorney General Bonta and the coalition filed a lawsuit challenging nine separate provisions of the final rule, arguing that they would make it harder for consumers to get coverage through the ACA, increase costs for states, and weaken key ACA protections. Seven were later vacated in separate litigation, City of Columbus et al. v. Kennedy et al., in the U.S. District Court for the District of Maryland. Yesterday, the U.S. District Court for the District of Massachusetts ruled that the Trump Administration unlawfully modified the categories of essential health benefits without following the proper procedures the ACA requires.